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Summary Report February 2018

A Clear Business Case for Hiring Aspiring Workers: Findings from a research project that looked at the costs and benefits of recruiting and retaining people living with mental illness

AcknowledgmentsThis report summarizes the results of a research project funded by the Mental Health Commission of Canada (MHCC) and authored by Rebecca

Gewurtz (McMaster University), Emile Tompa (Institute for Work & Health), Rosemary Lysaght (Queen’s University), Bonnie Kirsh (University of Toronto),

Sandra Moll (McMaster University), Sergio Rueda (Centre for Addiction and Mental Health), Karen Harlos (University of Winnipeg), Hélène Sultan-Taïeb

(University of Québec at Montréal), Arlene MacDougall (Western University), Margaret Oldfield, Katie Cook, Angela Xie, Kathy Padkapayeva (project staff,

McMaster University and the Institute for Work & Health) and Krista Benes, Cara Kane, Abela Ouedraogo, Nitika Rewari (project staff, Mental Health

Commission of Canada).

The full research report, The Aspiring Workforce in Canada: Building the business case for employers to actively recruit and retain people living with mental

illness, can be requested from the Mental Health Commission of Canada, [email protected].

Ce document est disponible en français

Citation InformationSuggested citation: Mental Health Commission of Canada.

A Clear Business Case for Hiring Aspiring Workers: Findings from a research project that looked

at the costs and benefits of recruiting and retaining people living with mental illness. (2018). Ottawa, ON:

Mental Health Commission of Canada.

Retrieved from www.mentalhealthcommission.ca

Copyright© 2018 Mental Health Commission of Canada

The views represented herein solely represent the views of the Mental Health Commission of Canada.

Production of this document is made possible through a financial contribution from Health Canada.

ISBN: 978-1-77318-052-6 (Online)

ISBN: 978-1-77318-057-1 (Print)

Legal deposit National Library of Canada

A Clear Business Case for Hiring Aspiring Workers | 1

Executive SummaryLabour shortages in Canada are projected to reach close to two million workers by 2031, costing the Canadian

economy billions in lost GDP annually. Additionally, rising rates of absenteeism, presenteeism, and turnover are now

requiring employers to use innovative ways to recruit and retain a qualified labour force.

Most people living with a mental health problem or illness want to

work and can make important contributions to the workforce if they

are adequately supported. This report presents the business case for

employers to actively recruit and accommodate people living with

a mental illness through an in-depth examination of the financial,

social and organizational costs and benefits. The focus is on Aspiring

Workers, those people who, due to mental illness, have been unable to

enter the workforce, who are in and out of the workforce due to episodic

illness and are struggling to remain in the workplace, or who wish to return

to work after a lengthy period of illness.

MethodologyFive Canadian businesses that have championed workplace mental health

and taken active steps to hire and support the Aspiring Workforce were

selected to carry out the research. Within each organization researchers

spoke to a diverse group of stakeholders, including workers living

with serious mental illness, co-workers, managers, human resource

professionals, and individuals who have championed hiring and supporting

people living with mental health problems and illnesses. Data was gathered

through three main approaches: 1) qualitative interviews 2) interviews with

individual stakeholders about the costs and benefits of accommodating

a worker living with a mental illness, and 3) workplace observations and

a review of key organizational documents. A comprehensive economic

analysis was carried out to calculate the total costs and benefits over a

five-year (projected) time frame to estimate net benefit and benefit-to-cost

ratios for workers and employers.

FindingsAcross all five organizations, the research revealed that attending to

healthy workplace culture is critical to supporting the diverse needs

of workers. As well, the research found that many workers living with

mental illness seem to rely on informal processes for securing workplace

accommodations, either by drawing on universally available supports such

as sick days, or negotiating an individual arrangement.

The economic data from across the different organizations highlight the

significant return on investment for both accommodated workers and

employers. These findings were validated from diverse workers, in diverse

settings, from diverse perspectives and highlight a win-win proposition.

Calculations include monetary and non-monetary costs and benefits that

can be showcased to present a compelling business case for strategically

hiring and accommodating people from the Aspiring Workforce.


RecommendationsThe findings highlight several recommendations for organizations seeking to innovate around hiring and accommodating workers living with a mental health

problem or illness.

1. Build an inclusive workplace culture that values diversity, embraces open communication and worker engagement by drawing on existing resources such as the National Standard of Canada for Psychological Health and Safety in the Workplace.

2. Develop standards and guidelines for proper communication that foster workplace civility. All members, including leaders and managers within the organization, should model civility in their interpersonal interactions. Short, focused training modules that are delivered on-line or in-person can be effective in helping identify language that can be (unintentionally) offensive, rude, or disrespectful.

3. Attend to workplace physical and social environments and ensure they allow for adequate flexibility to meet the needs of people living with a mental health problem or illness, such as sufficient sunlight, designated areas respecting a worker’s privacy, office configurations for those with difficulty concentrating that avoid excessive stimulation, and opportunities for peer support and collaboration.

4. Offer and strengthen supports and benefits (such as sick days) available to all workers as an important way to accommodate many mental health issues in the workplace. Our findings and other research indicate that universal supports for mental health in the workplace can be an effective strategy, including enhanced benefits plans that encompass a range of health supports. Coverage can vary widely among plans so employers are encouraged to confirm inclusion of evidence-based medications as well as access to psychological services.

5. Build in flexibility where possible – in terms of how, where and when people work. Managers should be open to a range of work arrangements, and seek innovative and non-traditional approaches to fostering productivity in their particular work sector.

6. Encourage work teams and groups to connect, support and recognize each other, both formally and informally, through peer-support initiatives, team-building and worker-recognition events.

7. Document informal accommodation arrangements in writing, whenever possible, so that the nature and scope of options are clear, transparent, and stable through organizational change.


BackgroundThe value of quality employment for the maintenance and improvement of mental health for all people is clear and

widely understood. Employment not only provides a paycheck, but also a sense of purpose, opportunities to learn

and a chance to connect with others through work.1 More importantly, work offers hope for improved health and

functioning, which is vital in the recovery from mental illness.2 Research shows that individuals living with a disability

(including those living with a mental illness) can be just as qualified, reliable, safe, loyal, and high-performing as their

colleagues who do not have a disability.3

Since its inception in 2007, the Mental Health Commission of Canada

(MHCC) has placed a significant focus on the promotion and protection

of workers’ mental health in the workplace and eliminating barriers

to employment for individuals living with mental health problems and

illnesses. In 2013, the MHCC and key partners released The Aspiring

Workforce: Employment and Income for People with Serious Mental

Illness. Aspiring Workers are people living with a mental health problem

or illness who have been unable to enter or remain in the workforce,

are in and out of work due to episodic illnesses, or want to return after a

long absence. The intent of the Aspiring Workforce project was to identify

existing and innovative practices that would help people living with a

serious mental illness to secure and sustain meaningful employment

(or sustainable income). Key recommendations from the report include a

paradigm shift to de-stigmatize people living with serious mental illnesses,

better collaboration across stakeholders and levels of government,

removing disincentives to return to work and increasing the knowledge

of both the worker and employer to be aware of their rights and resources

available to them to support the Aspiring Workforce.

In an effort to carry out the recommendations in the Aspiring Workforce

Report, the MHCC hired a research team4 to study the business case for

employers to recruit and accommodate people living with a mental illness

through an in-depth examination of the financial, social and organizational

costs along with benefits to both employers and workers. This report

is a summary of that study. The results of this research present clear

advantages for both Canadian businesses and workers: hiring Aspiring

Workers makes good business sense.


Canadian Business Needs and OpportunitiesMental health problems and illnesses are the leading causes of disability in Canada, affecting almost seven million

working age adults.5 In fact, mental illness costs Canadian employers over $20 billion annually due to losses related to

turnover, absenteeism, and presenteeism.6 Approximately $9.6 billion is spent each year on disability support benefits

for people in Canada living with a mental illness who are not working. Meanwhile, the Canadian Chamber of Commerce

has identified skills shortages as one of the top 10 barriers to competitiveness in Canada, with one source estimating

a workforce shortage of two million by 2031 and a cost to the Canadian economy of billions in lost GDP annually.7,8

Undoubtedly, there is a need to consider innovative strategies to help businesses actively engage the Aspiring

Workforce towards stable, fulfilling employment.

Although there is a general social trend towards inclusiveness, there

are numerous barriers that continue to impede the full integration and

acceptance of persons living with mental illnesses in contemporary society,

including their access to income and employment security. A web of silence

often surrounds mental health issues, shaped by lack of knowledge, stigma,

confidentiality concerns and workload pressures. These factors often

prevent members of the Aspiring Workforce from disclosing their illness,

seeking help for themselves or reaching out to others. Mental illnesses

can be episodic or recurring, and may result in unexpected and

unpredictable behaviours9,10,11 that make workplace accommodation and

acceptance challenging. Once hired, people living with a mental illness are

more vulnerable to workplace mistreatment, bullying and harassment than

other workers.12,13

Despite the costs of mental illness and benefits of building psychologically

healthy workplaces14, little is known about building workplaces that

effectively support the Aspiring Workforce. People living with a mental

illness are much less likely to be employed. In fact, unemployment rates

are as high as 70% to 90% for people with the most severe forms of

mental illnesses. Many workplaces have learned how to accommodate

workers with physical disabilities15,16 but still struggle to create integrative

and supportive workplaces for people living with a mental illness17,18.

The National Standard of Canada for Psychological Health and Safety

in the Workplace (“the Standard”) is a promising new development in

workplace mental health, providing voluntary guidelines that promote

workers’ psychological health and prevent harm.19 Evidence is lacking,

however, as to what these guidelines should recommend and how they

can be leveraged to attract and successfully employ people living with a

mental illness in ways that promote psychosocial health.

There is an urgent need for sound evidence of the costs and benefits of

accommodation, with a particular focus on people living with a moderate

to severe mental illness. The following sections present a summary of the

results of this business case inquiry, including workplace strategies and

good practice guidance to assist Canadian employers in this endeavour.


The Study

GoalThe goal of this research was to generate evidence-based

recommendations for employers regarding strategies to foster a

productive, engaged, and healthy workforce that can meet Canadian

business needs and enhance competitiveness in local, national, and global

arenas. The key questions were: What is the business case for employers

to recruit people living with a mental illness and what organizational

strategies and practices best promote recruitment and retention of people

living with a mental illness in Canadian workplaces?

ObjectivesThe specific objectives of the project were to:

1. explore the barriers, opportunities, risks and benefits of hiring and retaining people living with a mental health problem or illness from the perspective of key workplace stakeholders (people living with a mental illness, co-workers, employers) in a range of organizations varying by size and industry;

2. identify and describe the costs and benefits associated with hiring, supporting and accommodating people living with a mental illness; and

3. identify opportunities and strategies for employers to improve their capacity to successfully hire and retain workers from the Aspiring Workforce.

MethodologyTo address the research question and objectives, the researchers

conducted case studies of five diverse Canadian businesses (see chart)

recruited from three Canadian provinces.

Within each organization, researchers spoke with a diverse group of

stakeholders, including workers living with a mental illness20, co-workers,

managers, human resource professionals, and “champions” for hiring

and supporting people living with a mental illness. Data was gathered

using three main approaches: 1) qualitative interviews with individual

stakeholders about their experiences working in the organization;

2) interviews with individual stakeholders about the costs and benefits of

accommodating a worker with a mental illness; 3) workplace observations

and a review of key organizational documents.

A comprehensive economic analysis calculated the total costs and benefits

over a five-year (projected) time frame to estimate net benefit and

benefit-to-cost ratio for workers and employers. Workers self-identified as

having a mental illness that could cause impaired functioning at work.

Thirty-four individuals were interviewed across the five Canadian

organizations, including 12 workers with mental illness, 12 managers,

seven co-workers, and three additional champions.


5

GOVERNMENT

LargePublic

(Nova Scotia)Government Yes

ORGANIZATION TYPE OF BUSINESS SIZESECTOR AND

PROVINCE URBAN OR RURALPROFIT

ORIENTATION UNIONIZED

1

CAFÉ

Small

Consumer/ Survivor Run

Social Enterprise (Ontario)

Aims for profit No

2

CATERING

SmallPrivate Social

Enterprise (Ontario)

For-profit No

3

FARMING

MediumPrivate

(Ontario)For-profit No

4

BANK

LargeCrown Corporation

(Alberta)For-profit Yes

Notes: Small = < 100 employees. Medium = > 100 < 500 employees. Large = > 500 employees.


FindingsThree overarching themes emerged from the interviews.

The findings highlight how key organizational principles and strategies

identified in different workplace settings impact the experiences of people

living with a mental illness, their co-workers, and their managers.

These themes describe organizational features that can help or hinder

inclusion and support, with implications for people living with mental

health problems and illnesses, their co-workers and managers. As well,

the themes speak to how the needs of people living with a mental illness

are accommodated in workplaces and the strategies and practices to

support the hiring of people living with a mental illness.

Theme 1: Culture of Inclusion“Culture of inclusion” refers to the various

ways a workplace achieves inclusion of all

workers, through measures such as access

to safe spaces and promotion of positive

relationships, supportive work relationships,

and employee engagement. Inclusion was a

common theme discussed by key informants

during interviews across all the organizations.

Four of five organizations had implemented

practices and processes to ensure psychological

safety and respect, in terms of how workers

communicate with one another. In most of the

organizations, there were policies for workplace

civility to promote courtesy, politeness,

and consideration for others.

Examples from interviews that helped

foster a culture of psychological safety

and respect include:

• ensuring that workers use respectful language that does not stigmatize or belittle others;

• modifying the work environment. For example, having quiet and private space for employees to work;

• checking in with each other and supporting each other during challenging times; and

• providing opportunities for engagement in decision-making. For example, workers can be asked for their opinions and feedback so that they feel recognized, valued and respected.

“Every staff meeting starts with a check‑in. How’s everyone doing? Not just in your jobs, but in your mental health, in your life.”

– Co-worker, Small, Food Services, Social Enterprise

Although an organization might adopt

psychological safety and respect as a strategy

to promote inclusion, managers’ behaviours and

practices need to be aligned. One informant

described the problem of non-alignment –

“I think that our leaders are on board but I’m

not sure that our management is on board and

that’s kind of where it’s hit and miss.”


Recommendations for Employers to Foster a Culture of Inclusion:

• Build an inclusive workplace culture that values diversity, embraces open communication, and promotes worker engagement by drawing on existing resources such as the Standard.

• Develop standards and guidelines for proper communication that foster workplace civility. All members, including leaders and managers within the organization, should model civility in their interpersonal interactions. Short, focused training modules that are delivered on-line or in-person can be effective in helping identify language that can be (unintentionally) offensive, rude, or disrespectful.

• Attend to workplace physical and social environments and ensure they allow for adequate flexibility to meet the needs of people living with a mental illness, such as sufficient sunlight, designated areas respecting a worker’s privacy, office configurations for those with difficulty concentrating that avoid excessive stimulation, and opportunities for peer support and collaboration.

Peer Support

An important contributor to recovery,

peer support, is a supportive relationship

between people who have a lived

experience in common. The peer support

worker provides emotional and social

support to others who share a common

experience, and can help foster a culture of

inclusion in the workplace. Despite evidence

of the benefits for both individuals and

families, peer support programs have

yet to receive the focus, funding, and

attention needed.

Take a closer look at MHCC’s Guidelines for

the Practice and Training of Peer Support.

Theme 2: Accommodations for Workers Living with a Mental Illness By the time Canadians reach 40 years of age,

1 in 2 has – or has had – a mental health

problem or illness.21 As such, employers are

hiring and retaining individuals living with

a mental illness. However, only one case

study organization described having a formal

accommodation plan for mental health disability

(which was part of a worker’s gradual return

to work after disability leave). Rather, many

respondents interviewed in the study relied

on supports and benefits available to all

workers, such as sick days and work-from-

home policies to accommodate their needs.

This finding reinforces the need for

organizations to ensure that the benefits and

supports offered to all workers are sufficient,

and to strengthen them where possible.

Interestingly, the move towards flexible work

could also have negative consequences for

people with mental illness. For example, flex

time seems to have changed attitudes towards

“sick” and “personal” time, as individuals

were now expected to “flex” their hours and

put in extra time to compensate for time off.

Furthermore, under this new approach, there

may be an expectation for workers to work

very long hours to complete required tasks

without any recognition.

At times, workers make special requests and

negotiate with their direct supervisors to

access the supports and accommodations

they need. When individual accommodations

for mental illness were needed, they were

typically negotiated informally between

workers and their managers. Although

many preferred keeping the negotiation

of individual accommodations informal,

it did create some uncertainty and risk.


Typically, these arrangements were not written

down and depended on verbal agreements.

They required managers to be sympathetic and

understanding of the need for accommodation,

and for a culture of support within the

organization. Second, the informal nature of

these arrangements raised concerns about

their sustainability as organizations change

and evolve. Although some organizations

had work-from-home options available

to many workers, this varied across and

within organizations. Not every position was

conducive to working-from-home options,

and often this was approved on a case-by-case

basis. Therefore, at times workers had to

make special requests and negotiate with their

direct managers to access the supports and

accommodations they needed.

“If the person in a decision‑making (position) starts from the place that they want to help… they want to accommodate, but stay true to what they need to achieve as a department… that’s kind of the recipe for success.”

– Executive, Mid-sized, For-profit, Rural, Agricultural Business

“The fear that somebody might gossip can hold people back from disclosing or divulging information that could be really helpful for them.”

– Champion, Large, Public Sector Organization

Disclosure was not an issue in all of the

organizations; however, the invisibility of

many mental health problems can create

circumstances where co-workers interpret

accommodations as special treatment.

This lack of understanding of mental illness

and workplace accommodations sometimes

led to gossip and stigma, and perpetuated

the hesitancy to disclose and request

accommodations.

Recommendations for Employers around Accommodations for People Living with a Mental Health Problem or Illness:

• Offer and strengthen supports and benefits (such as sick days) available to all workers as an important way to accommodate many mental health issues in the workplace.

• Build in flexibility where possible – in terms of how, where and when people work. Managers should be open to a range of work arrangements, and seek innovative and non-traditional approaches to fostering productivity in their particular work sector.

• Encourage work teams and groups to connect, support and recognize each other, both formally and informally, through peer support initiatives, team building and worker recognition events.

• Document informal accommodation arrangements in writing whenever possible so that the nature and scope of options are clear, transparent, and stable through organizational change.


Theme 3: Hiring People Living with a Mental Illness The study explored issues around hiring

within each organization, given the difficulty

individuals from the Aspiring Workforce have

in gaining employment. Two organizations had

mandates to only hire people living with mental

illness or those facing barriers to employment.

For this reason, they looked for people with

lived experience who could fill vacant positions.

Conversely, the other three organizations did

not actively recruit from the Aspiring Workforce

and only one worker interviewed had identified

himself as having a mental illness when he was

hired. Although multiple key informants noted

that their organizations did not track the hiring

of any specific groups, the two organizations

that actively hired people with lived experience

reported low turnover, which was surprising,

given that they were in the food industry,

which has a high rate of employee turnover.

“For the [food services] industry we have low turnover. Typical restaurant turnover is about 40% annually. Ours is in the 10‑15% range. So, people do tend to stay here.”

– Manager, Small, Food Services, Consumer-run Enterprise


Economic Analysis of Costs and Benefits to Workers and Employers for Recruitment and Retention of the Aspiring WorkforceThis section presents cost-benefit case studies of accommodated workers within the organizations. An economic

analysis was not completed on Organization 3, a mid-sized, for-profit, rural, agricultural business, because of

complexities which prevented the recruitment of an accommodated worker. Stylized case studies have been

designed to profile the findings from the economic analysis of data collected from multiple stakeholders, including

accommodated workers, co-workers, and managers/supervisors. A detailed breakdown of cost-benefit ratio

calculations is found in the full report, which is available upon request. The table (next page) shows the generic items

that guided the interviews for the cost-benefit analyses.

Benefits are often more difficult to estimate than costs. The study distinguished between tangible and intangible benefits, the latter of which are benefits

that cannot be easily measured and quantified.


Costs and Benefits/Impacts Considered from the Organizations’ Perspective

ITEMS COSTS BENEFIT/IMPACTS (TANGIBLE) BENEFIT/IMPACTS (INTANGIBLE)

Related to work time and productivity

Time spent to make the accommodation (planning, evaluation, training, maintenance, other time)

Cost of providing a flexible schedule for the accommodated worker

Work absences (days, replacement costs)

Turnover

Productivity at work

Related to external or material expenses

Professional/Consultant fees

Equipment purchases

Insurance and other payroll costs

Fines related to compliance violations

Other Other costs of the accommodations Other benefits/impacts Job satisfaction

Intent to stay

Organizational citizenship and workers’ commitment (accommodated worker, co-workers)

Organizational climate

Items used from the accommodated workers’ or the co-workers’ perspectives were different. On the cost side, the study identified unpaid time spent

by workers on planning, implementing the accommodation and getting trained to use it, and impacts incurred by the flexible schedule of accommodated

workers. On the benefit side, the study identified a variation in workload and productivity at work, a variation in the intent to stay in the organization,

the perception of the organization (organizational citizenship, work climate), as well as quality of life at work and outside work, work-life balance, and

satisfaction.

More detailed definitions of cost and benefit items used in the economic

evaluation are provided in Appendix A.

In the study, total costs and total benefits were computed separately

for the economic perspective of the organization and for the perspective

of accommodated workers, where data allowed for such quantitative

estimates. Total costs and benefits were projected over a five-year

period. Net benefit was computed as the difference between benefits

and costs. Benefit-to-cost ratio (total benefits divided by total costs)

was also computed.


Organization 1 – Small, Food Services, Consumer-run Enterprise

This is a small, consumer-run business that explicitly aims to hire

individuals living with a mental health problem or illness (including

managers). This organization was established approximately 15 years ago

and currently operates four cafés as well as providing catering services

across a large city.

The accommodated worker is a cook who prepares food for a café and

catering service. When the manager is absent, the cook also takes on the

role of assistant manager. The position is part-time, entailing approximately

20-30 hours per week. The person has worked for the organization for

six years.

Position Chef, Assistant Manager

Health Condition Epilepsy, challenges with short-term memory, episodes of major depression

Accommodation The manager has accommodated the cook’s health conditions by:

• writing down daily tasks;

• running through the tasks the day before they are to be executed to help her remember details;

• sending reminders through text messages and regularly checking in; and

• being flexible with scheduling to make it fit with the worker’s personal/family needs.

5-year net worker benefits

benefit-cost ratio for the worker

$44,108

9.45

5-year net organization benefits

benefit-cost ratio for the organization

$55,596

2.25

These results show that after a five-year period, benefits amount to almost

10 times the costs from the perspective of the worker, and more than

two times the costs from the organization’s perspective. From this latter

perspective, benefits derive mainly from increased productivity at work

due to accommodations. Costs are mainly due to additional supervisory

staff and training.


Organization 2 – Small, Food Services, Social Enterprise

This is a small, urban, relatively new for-profit catering company. Most of

the workers are living with a mental illness, including the owner, and some

workers have other disabilities as well.

The accommodated worker washes dishes, helps with the preparation of

food for catering orders, and on occasion assists with serving at events.

He is a member of the core staff of the organization. He works an average

of 30 hours per week and is paid the minimum hourly wage. This person

has worked for the organization for five years.

“As a social enterprise, we see creating accessible and sustainable employment as a beneficial end in and of itself regardless of financial profits – money, time, and resources invested in that effort are never lost! Furthermore, investing in people who otherwise have barriers to the workforce results in loyal and dedicated staff, with less sick days and staff turnover. We have discovered that when you go above and beyond for your staff, they will in turn go above and beyond for you.”

– Owner, Small, Food Services, Social Enterprise

Position Dishes, food prep, serving

Health Condition Bipolar disorder and intellectual disability

Accommodation The owner has accommodated the worker by:

• allowing him to sit while working;

• permitting access to his phone at all times;

• offering a flexible pay schedule;

• providing support with applications; and

• providing assistance getting to appointments.



$30,764

4.23



$134,032

1.92

In this organization, the difference in benefit-to-cost ratio between the organization’s and the worker’s perspective was lower than in the previous

organization. From the organization’s perspective, benefits mainly came from higher productivity at work due to the accommodations. To a lesser extent,

benefits were provided by an increased intent to stay, the supervisor and a lower staff turnover as compared to the average level in the food industry.


Organization 4 – Large, Crown Corporation, Banking

This is a provincial, for-profit Crown Corporation mandated to provide

banking services to individual and business customers. It has 5,000

workers in 300 locations across the province.

The accommodated worker is a business analyst at the head office, and she

also assists the human resources department with mental health initiatives

for the organization. She splits her time between these two responsibilities

in a proportion of approximately 80% business analyst and 20% human

resources. She began these new responsibilities only a few years ago,

but has been with the organization for a decade working as an analyst

in another office.

This person is known to be a high performer and has received awards

for her work. She is also one of the first people in the organization to

disclose her mental health condition. This has given her a high profile in

the organization, and she is considered an inspiration and a role model

for others in the organization.

“We work hard to create a culture that is inclusive and respectful. By supporting physical, financial, mental, spiritual and overall organizational health while encouraging team members to be accountable to use the tools and resources available, we believe this can positively impact the mental health of all team members. By employing people with mental health issues, we demonstrate this commitment to create a safe and inclusive environment for all team members and future team members to be ALL IN.”

– Human Resources Director, Large, Crown Corporation, Banking

Position Business Analyst

Health Condition Severe depression and obsessive-compulsive disorder

Accommodation This worker has been accommodated by:

• offering her soft measures such as patience and extra time;

• providing her with two computer screens; and

• working from home and flex hours (but not currently).



Intangible – job satisfaction, quality of life, organizational citizenship



$210,804

7.40

In this organization, the benefit-to-cost ratio from the organization’s perspective is high, as a result of benefits over a five-year period due to a higher

productivity at work and a higher intent to stay of the manager. Costs are lower than in the other organizations.


Organization 5 – Large, Public Sector Organization

This is a provincial government agency with multiple sites and

11-12,000 workers, most of whom are unionized.

The accommodated worker is an inspector who has worked with the

organization for 12 years. Much of his time is spent in the field, but

he needs to check in at the office at the start and end of each day.

The hours are set, so there is no flexible schedule, and the work must be

done on site. The person experiences severe depression and has episodic

anxiety attacks.

“Employment offers people means to support themselves and their families, a feeling of purpose and value....these are things every person should have, including those who have mental health concerns.”

– Employee, Large, Public Sector Organization

He is open with his manager and co-workers about his mental illness.

His colleagues are supportive of his condition and accommodation

needs. In addition, he sometimes uses his sick days and vacation time,

and has taken a medical leave of absence, which are benefits available

to all employees.

Position Inspector

Health Condition Severe depression and episodic anxiety attacks

Accommodation The manager has accommodated this worker by offering regular check-ins to ensure the accommodation process is working effectively and factors such as attendance and workload are considered.



$67,171

12.19



$203,650

7.81

In this organization, the benefit-to-cost ratio is high, benefits are mainly due to a higher productivity at work.


KEY RESULTSEconomic benefits

Intangible benefitsThe intangible benefits identified by respondents listed below are not reflected in the economic analysis, as they are difficult to quantify; however, they are

still important and were emphasized by the respondents.

INTANGIBLE BENEFITS FOR THE ORGANIZATION INTANGIBLE BENEFITS FOR ACCOMMODATED WORKERS

• Increased job satisfaction of workers

• Increased quality of work life

• Improved organizational climate/culture

• Improved relationship between co-workers

• Higher degree of organizational citizenship

• Increased organizational reputation

• Increased quality of work life

• Increased quality of life outside of work

• Improved organizational climate/culture

• Increased employment opportunities

• Increased work-life balance

• Higher degree of organizational citizenship

• Improved relationship between co-workers

• Increased job satisfaction

COST

BENEFIT

2 TO 7 TIMES

TO THE ORGANIZATION

In all four case studies, there was an economic benefit to the organization ranging from 2-7 times the cost of

accommodating workers.

COST

BENEFIT

4 TO 12 TIMES

TO THE WORKER

In all four case studies, there was an economic benefit to the worker ranging from 4-12 times the cost.


Conclusion & Next StepsThe strategic decision to actively hire and retain people living with a mental health problem or illness presents clear

advantages for diverse Canadian businesses and workers. The findings showcase businesses that have championed

workplace mental health and taken active steps to hire and support people with mental illnesses. The business cases

presented here provide compelling evidence that the benefits of pursuing healthy work environments for the Aspiring

Workforce outweigh the costs. The innovative approach the researchers developed and applied to estimate the costs

and benefits of accommodation in this study can be adapted by businesses for use in their own contexts.

The next phase of the research project will involve developing a tool based

on the cost-benefit calculations used in this report and seeking feedback

from employers and other stakeholders. This tool will be tested to ensure

employers at large are able to adopt/use it in their own environments to

calculate the costs and benefits of recruiting and retaining workers from

the Aspiring Workforce. The MHCC will work with the research team to

produce an employers’ guide to assist with the practical implementation

of this tool and to successfully build an inclusive work environment that

includes people living with a mental health problem or illness.

We need to change the conversation about workers with mental illness;

we need to recognize that they can be productive, loyal employees with

the right supports in place that not only benefit them, but the overall work

environment. As one of our employers discovered, “when you go above

and beyond for your staff, they will in turn go above and beyond for you.”


Appendix ATable 1: Items considered in the economic analysis with managers and supervisors.

COSTS DEFINITION (used with manager/supervisor)

Planning people time for planning the accommodations

Evaluation people time for evaluating the accommodations

Training people time for extra training or specialized training

Professional/Consultant Fees costs of services from an outside organization

Equipment Purchases cost of equipment purchases

Accommodation Maintenance people time for ongoing meetings to make the accommodations work for the worker

Other Time people time in other activities related to making the accommodations work for the worker

Flexible Schedule costs incurred by the organization because the accommodated worker has a flexible schedule

Other Costs other costs incurred by the organization related to the worker’s accommodation


BENEFITS/IMPACTS (tangible and intangible) DEFINITION (used with manager/supervisor)

Job Satisfaction your level of contentment and involvement with your job

Intent to Stay your intentions about staying with your current employer

Work Absences time the accommodated worker takes off work due to their disability and related health needs

Work Absence Replacement Costs expenses of replacing the accommodated worker when absent

Productivity at Work (accommodated worker) quality of the accommodated worker's work output and the time it takes to get things done

Productivity at Work (co-workers) quality of co-workers' work output and the time it takes to get things done

Organizational Citizenship (accommodated worker) accommodated worker's commitment to the organization that is over and above their regular responsibilities

Organizational Citizenship (co-workers) co-workers' commitment to the organization that is over and above their regular responsibilities

Staff Turnover proportion of workers leaving the organization in a given period of time

Attraction and Retention ability of the organization to attract and keep workers

Organizational or Work Unit Climate/Culture workers’ opinions and experiences about the organization

Organizational Accountability the organization's sense of doing what it is supposed to do

Organizational Reputation how external stakeholders view the organization

Insurance and Other Payroll Costs payroll expenses such as short-term disability, long-term disability, Employment Insurance, Canada/Quebec Pension Plan

Compliance-related Expenses fines incurred by the organization and time required to respond to compliance violations

Other Benefits/Impacts other benefits/impacts incurred by the organization because of the accommodations


Table 2: Items considered in the economic analysis with co-workers.

COSTS DEFINITION (used with co-workers)

Training your time in extra training or specialized training

Accommodation Maintenance (meetings with the accommodated worker) your time in ongoing meetings time to discuss the accommodations with the worker

Other Time your time in other activities related to making the accommodation work for the worker

Flexible Schedule costs you incur because the accommodated worker has a flexible schedule as part of their accommodation (flexible schedule includes different hours, working from home, more breaks, etc.)

Other Costs other costs you have that are related to the worker’s accommodation


BENEFITS/IMPACTS (tangible and intangible) DEFINITION (used with co-workers)

Workload amount and intensity of your work

Relationship with the Accommodated Worker quality of your relationship with the accommodated worker



Work Life Balance time and energy you have to do all the things that are important in your life

Quality of Work Life your opinion about how good your work life is

Quality of Life Outside of Work your opinion about how good your life is outside of work

Organizational or Work Unit Climate/Culture your opinions about and experiences with the organization

Productivity at Work quality of your work output and the time it takes you to get things done

Organizational Citizenship your commitment to the organization that is over and above your regular responsibilities

Other Benefits/Impacts other benefits/impacts you have incurred


Table 3: Items considered in the economic analysis with accommodated workers.

COSTS DEFINITION (used with accommodated workers)

Planning your time in the planning the accommodations

Evaluation your time in evaluating the accommodations

Training your time in extra training or specialized training

Accommodation Maintenance (meetings with supervisor/manager/human resources)

your time in ongoing meetings with your supervisor/manager or human resources to discuss your accommodations

Other Time your time in other activities related to making your accommodations work

Flexible Schedule costs you incur because of having a flexible schedule (flexible schedule includes different hours, working from home, more breaks, etc.)

Other Costs other costs you have that are related to making your accommodations work

BENEFITS/IMPACTS (tangible and intangible) DEFINITION (used with accommodated workers)

Income from Work your earnings from work



Employment/Career Opportunities your ability to develop a career and be productive in the paid labour force

Work Life Balance time and energy you have to do all the things that are important in your life

Quality of Work Life your opinion about how good your work life is

Quality of Life Outside of Work your opinion about how good your life is outside of work

Workload amount and intensity of your work


1. Road to Recovery: Employment and Mental Illness, National Alliance on Mental Illness, 2014.

2. Guidelines for Recovery-Oriented Practice, Mental Health Commission of Canada, 2015.

3. Partnership council on employment opportunities for persons with disabilities. “Employable Until Proven Otherwise” 2017.

4. The full research report includes a list of the entire research team. Gewurtz, Rebecca et. al. “The Aspiring Workforce in Canada: Building the business case for employers to actively recruit and retain people living with mental illness.” Final Report. October 2017. Available from MHCC staff upon request.

5. Mental Health Commission of Canada, Making the case for investing in mental health in Canada. 2016, Available from http://www.mentalhealthcommission.ca/sites/default/files/2016-06/Investing_in_Mental_Health_FINAL_Version_ENG.pdf: Ottawa, ON.

6. Conference Board of Canada, Healthy brains at work: Employer‑sponsored mental health benefits and programs. 2016, Accessed from, http://www.sunlife.ca/static/canada/Sponsor/About Group Benefits/Focus Update/2016/557/HealthyBrains_Report2_EN.pdf: Ottawa, ON.

7. The Canadian Chamber of Commerce. A Battle We Can’t Afford to Lose.

8. Rick Miner “The Great Canadian Skills Mismatch: People without Jobs, Jobs without People and MORE” 2014.

9. Gewurtz, R. and B. Kirsh, Disruption, disbelief, and resistance: a meta‑synthesis of disability in the workplace. Work: a Journal of Prevention, Assessment & Rehabilitation, 2009. 34: p. 33-44.

10. Lysaght, R., T. Krupa, and A. Gregory, Employers’ perceptions on intermittent work capacity ‑ What can qualitative research tell us? 2011, Queen’s University: Kingston Ontario.

11. Vick, A., Living and working precariously with an episodic disability: Barriers in the Canadian context. Canadian Journal of Disability Studies, 2014. 3(3): p. 1-28.

12. Carter, M., et al., Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting. BMJ Open, 2013. 3(6): p. 245-277.

13. Fevre, R., et al., Trouble at work. Vol. 4. 2012, London: Bloomsbury Academy. 245-277.

14. Kelloway, E.K. and A.L. Day, Building healthy workplaces: What we know so far. Canadian Journal of Behavioural Science, 2005. 37(4): p. 223-235.

15. Nevala, N., et al., Workplace accommodation among persons with disabilities: A systematic review of its effectiveness and barriers or facilitators. Journal of Occupational Rehabilitation, 2015. 25: p. 432-448.

16. Tompa, E., et al., Evidence synthesis of workplace accommodation policies and practices for persons with visible disabilities. 2015, Accessed from https://www.crwdp.ca/sites/default/files/documentuploader/full_report_-_evidence_synthesis_visible_disabilties_tompa_et_al._2015.pdf: Toronto, ON.

17. Smith, P.M., et al., Are the predictors of work absence following a work‑related injury similar for musculoskeletal and mental health claims? Journal of Occupational Rehabilitation, 2014. 24: p. 79-88.

18. Prince, M., Policies and practices on the accommodation of persons with invisible disabilities in workplaces: A review of Canadian and international literature. 2015, Accessed from https://www.crwdp.ca/sites/default/files/documentuploader/full_report_-_lit_review_on_persons_with_invisible_disabilities_in_workplaces_prince_2015.pdf: Victoria, BC.

19. Shain, M., Weathering the perfect legal storm: Navigating requirements of the emerging duty to provide a psychologically safe system of work in the context of the voluntary National Standard of Canada on Psychological Health and Safety in the Workplace, CSA Z1003-13/BNQ 9700-803. 2014, Accessed from https://www.workplacestrategiesformentalhealth.com/pdf/weathering_the_perfect_legal_storm_BEV_E.pdf: Toronto, ON.

20. Mental illnesses are characterized by alterations in thinking, mood or behaviour associated with significant distress and impaired functioning. (Public Health Agency of Canada, 2015).

21. Smetanin et al. (2011). The life and economic impact of major mental illnesses in Canada: 2011-2041. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.

Mental Health Commission of Canada

Suite 1210, 350 Albert Street Ottawa, ON K1R 1A4

Tel: 613.683.3755 Fax: 613.798.2989

[email protected] www.mentalhealthcommission.ca

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